Friday, January 23, 2015

A Social and Behavioral Critique on the Above the Influnce Campaign- Bianca Di Chiaro

Introduction:

The
use of marijuana in adolescents is a public health problem of national
importance because the number of smokers has been on the rise since the 1990s (1).
The National Youth Risk Behavior Survey
(YRBS), which is conducted every two years providing data from 9th
through 12th grade students, showed that some drug trends have begun
to increase. The survey showed that more students have used marijuana one or
more times, have used marijuana on school property one or more times, and have
been offered, sold or been given drugs on school property between 2009 and
2011. (2) The rising use of marijuana amongst peers can be linked to
adolescents decrease in perceived risk of using the drug. (3) It is imperative
that there is a public health focus on marijuana use in adolescents since their
age group is more susceptible to addiction. (4)

In response to the increased drug
use by adolescents in the United States, the National Youth Anti-Drug Media
Campaign was funded. (5) From 1998 to 2004 the United States Congress spent
over one billion dollars towards the campaign. (6) The main focus of the
campaign was to decrease drug use by educating, decreasing initiation, and convincing
users to stop. (7) The current campaign
is called Above the Influence, which targets adolescents with national
messaging through television, print, and the internet. Much of the campaign
focuses on commercials against the use of marijuana. One of the most frequently
aired Above the Influence commercials is a thirty second commercial in which an
adolescent who is high on marijuana is greeted in their kitchen by their dog.
The dog tells the adolescent how they wish they didn’t smoke pot and that they
are not the same when they are high.

While the National Youth Anti Drug
Media Campaign was able achieve high levels of media coverage the intended
message did not reach the targeted youths. Instead, many of the youths created
parodies of the commercial which can been seen all over the internet. Not only
did the message have the intended effect, the amount of coverage caused the
opposite to occur. The exposure decreased the youth’s intentions to stay away
from marijuana and decreased the antidrug social norms affiliated with
marijuana (6). Had the campaign focused on the social and behavior effects the
commercial would evoke, the overall goals of the campaign would have been more
successful. In the subsequent paragraphs the main problems with the commercial
used during this campaign will be discussed.

Critique:
Ineffective use of the Health Belief Model

The health belief model is a
psychological model developed to predict health behaviors in individuals. The
model first came about when a doctor wanted to better understand why many
people were not taking advantage of free tuberculosis testing that was
available to them. The Health Belief Model is used as a predictive tool for
behaviors such as life style behaviors, life style behaviors in relation to
health, and compliance with medication. An assumption that this model makes is
that individuals will engage in specific health behaviors if the outcome is
favorable to them. (8)

There
are six components of the health belief model, which were not effectively
used to create behavioral change in the
targeted youth of the Above the Influence campaign. The first component of the
model is perceived susceptibility, which demonstrates an individual’s
perception of their risk of developing the health issue. (8) In the commercial,
the use of marijuana is not displayed as a health risk. Not displaying the
health risks results in the targeted youths believing that marijuana is not a
major cause of health problems. The second component is perceived severity,
which demonstrates an individuals belief of the level of harm the health issue
would cause if the individual were to develop it. (8) Many youths do not perceive
marijuana use as harmful (3) and the commercial does not demonstrate the health
risks involved with smoking marijuana to achieve the behavioral change. The
next component is the perceived benefits. This component focuses on how
changing an individuals habits would have a health benefit to them. (8) While
the goal of the campaign is to show the benefits of not using or stopping the
use of marijuana, the campaign falls short because the commercial demonstrates
that if a person gets high they will have the benefit of talking to their dog. The
forth component is the perceived barriers, here the model focuses on the
obstacles an individual would face to maintain the beneficial health outcome. The
commercial does not display the negative outcome of using marijuana only the
positive outcome of communicating with their dog. The fifth component of the
theory are the cues to action. This component is based on continual stimulation
to increase the likelihood that the healthier choice would be made. Continual
exposure to the commercial makes marijuana seem like the common social norm
cuing the viewer into action to partake in drug use. The last component focuses
on self-efficacy, an individual’s confidence in their ability to demonstrate
the change. While a youth has the self-efficacy to decide to take action, not
taking drugs may not be the action that they are willing to take. (9)

The three main goals of the campaign
are to decrease drug use by educating, decreasing initiation of those who have
never smoked, and convincing youths who do smoke marijuana to stop (7). Instead
of reaching these goals to deliver a healthy drug free message the commercial
sends the message that if a person gets high they will be able to have
communications with their pet dog. It can be expected that many youths with
pets would want the opportunity to speak with their dog. The commercial could
have been more successful in translating their message into a behavior if they
had examined the effects of social and behavioral models.

Critique:
The Psychological Reactance Theory

The
psychological reactance theory is a psychological theory developed to explain
the reaction that occurs when an individuals freedom of behavior is threatened or
eliminated. The theory describes that an individual has a set of behaviors that
they can display at any moment within the realm of possibilities. In preparation of choosing their next
behavior, an individual takes in their internal and external surroundings.
After taking in their surroundings, the individual weighs which behavior would
bring them the most satisfaction in that moment. When one of their behaviors is
threatened or eliminated the individual feels the loss of their freedom. The
perceived loss of freedom causes reactance in the individual. Reactance is the
reaction that occurs due to this loss causing the individual to attempt to
reestablish their freedom of choice. (10) The Above the Influence commercial created
by the National Youth Anti-Drug Campaign causes reactance in the targeted youth
because the commercial threatens a behavior. The message of the Above the
Influence commercial is to not smoke marijuana and to those who do smoke, to
stop smoking marijuana. The message is
thus eliminating this behavior choice.

One
of the main goals of the campaign is to focus on the youth that are already
participating in smoking marijuana and convincing them to stop. Those that are
already actively smoking marijuana or have previously smoked will feel the most
reactance towards the message of commercial. The magnitude of reactance that is
felt by an individual depends on the worth of the behavior to the individual. The
greater the behavior is to the individual the greater the magnitude of
reactance. The youths that are actively participating in smoking marijuana will
have the greatest reactance towards the Above the Influence commercial. A smaller magnitude of reactance will occur
in those who have not smoked marijuana or have only smoked a small number of
times. The youth may not feel the reactance right away but when they feel their
freedom of choice challenged they will have an even stronger will to
reestablish their freedom. The reestablishing of their freedom occurs when they
partake in the behavior that was threatened or partaking in a similar behavior
such as smoking cigarettes. (10) The youths will be pushed towards the behavior
that was threatened. This means that youths who have never smoked may start and
those who do smoke will smoke more. The campaign is creating the opposite
effect then the desired behavioral change.

Another
aspect that plays a role in the magnitude of reactance is similarity. When there is similarity between the individual
and what the individual is observing, studies have shown a decrease in the
negative force of reactance and an increase in the positive force of
compliance. (11) In the commercial, a dog delivers the main message of the
National Youth Anti-Drug Campaign. A dog and adolescent are not similar. Having
a dog deliver the main message only increases the negative force of reactance
in the youth. In this aspect the commercial pushes the targeted population
further away from compliance with the main message of the campaign.

The
psychological reactance theory creates a motivational state (10), where the
youth may not have thought about wanting to try marijuana but the ad brings the
behavior into their mind. This behavior is then threatened or eliminated from,
in turn motivating them to take action against the commercial. The commercial
makes the targeted youth believe that their peers are using marijuana, which
increases the increases the likelihood
that they should also smoke marijuana (6) Here a youth who may have never
considered smoking marijuana may now have the intent to do so. The more times
the youth is exposed to the commercial the more reactance they will feel. The
psychological reactance theory may be able to explain why the intent to stay away
from marijuana decreased during the time after the Above the Influence
commercial campaign. (12)

Critique:
The Social Cognitive Theory

The
social cognitive theory is a psychological theory that was developed to explain
how environmental factors, personal factors, and human behavior interact. The
theory is used to describe how an individual gains knowledge through direct
observation. The media plays an
important outlet where individuals can observe and learn different behaviors.
Through the media, individuals can observe both an action and the consequences
while maintaining the sequence of events that led to behavior and outcome.
Observations can motivate an individual to act despite whether there is a
positive or negative reaction following the behavior. Through the Above the
Influence commercial, the targeted youth observe someone their age who is high
from smoking marijuana. The youth gains knowledge of the behavior and learns
the outcome, which in the commercial is hearing their dog talk to them.
Observing the commercial motivates the targeted youth to perform the behavior
instead of avoiding the behavior. (8)

There are three core determinants of the
social cognitive theory that can effect an individuals behavior. The first
determinant is based on an individuals understanding of the expected outcome.
The individual develops an expected outcome through gaining knowledge of the
risk related to the behavior. This knowledge can then create the condition for
change. (8) In the Above the Influence commercial, the behavior that changed
was not the goal of the campaign since a study found that youths were less
likely to stay away from marijuana following the message. (12) The youth
watching the commercial observes someone around their age, who is high and
listening to their dog talk to them. The youth then understands that if they
act the behavior of smoking marijuana their expected outcome is to talk to
their dog. The second determinant is
perceived self- efficacy and the third determinant is goals. This describes
that an individual must have the skills necessary for change and believe they
can make the change. Roles models can be factor that effects these determinants.
Applying these two determinants to the commercial, the youth see someone their
age, high and realize that they have the ability to get high and obtain the
same outcome. (8)

There are key concepts to the social
cognitive theory that can effect the main factors responsible for change. The
first concept is expectations; the anticipated outcome of the behavior. In the
commercial the only focus is on the outcome of smoking marijuana instead of focusing
on the benefits of not smoking. Another concept is behavioral capability;
having the skills to perform a behavior. With the widespread reach of the Above
the Influence campaign, many youths observe others their age getting high. The
observation creates the illusion that if their peers can get smoke marijuana
then they also have the ability to smoke marijuana. Another concept of this
theory is reinforcement, which is demonstrated by the wide spread media
campaign. The commercial creates the idea that smoking marijuana is more common
among youth and their peers increasing the likelihood of the behavior (12). Two
other concepts of this theory is modeling and observational learning. In the
Above the Influence commercial the targeted youth observes someone their age
getting high. The youth gains knowledge of what it looks like to be high as
well as gaining of knowledge from someone within their age group. Many of the
concepts that effect behavior, as described through the social cognitive
theory, caused an opposite effect of the main goals of the Above the Influence
campaign. (8)

Proposed Intervention:

Changing the Above the Influence campaign to
include social and behavioral theory will increase compliance of the National
Youth Anti-Drug Campaigns message. The main media source for the message would
remain on television since this outlet creates observation learning with high
sensation-value contexts. Studies show that messages geared towards older
teenagers and young adults are most persuasive through television. (1) A
commercial that shows a group of youths lead by a celebrity refusing to smoke
marijuana, the commercial then shows the group off having fun playing soccer
while the individual who offered the drugs is alone with anxiety. The use of a
celebrity is critical because the use of someone famous has been shown to
increase compliance with the health message. (14) The use of a similarly aged
group as the targeted youth is used since adolescents are more likely to
demonstrate behaviors similar to their peers (15). Instead of just stating the
smoking marijuana is bad, the commercial shows the risks creating a larger
impact (12) and demonstrating the benefits of saying no.

Solution: Health Belief model

The first critique of the Above the
Influence commercial addressed social and behavioral problems explained through
the health belief model. This theory describes that if there is a serious
enough threat to someone’s health, that person will avoid the action. (8) In
the Above the Influence commercial there is no threat to the youths health even
though the main message is to not smoke marijuana. A better direction to take
the commercial is to develop media that shows the health risk and severity that
can be relatable to the youths. (16) A successful campaign that targeted youths
to stop smoking cigarettes was the “truth” campaign. This campaign showed that
the risks described to youths to cause change had to be relatable to their
everyday lives such as pregnancy and divorce. The campaign demonstrated that
everyday risk factors had a larger impact then long term risk factors. They
found that youths had no reaction toward the risk of death because to them the
scary facts were not seen as a big deal. The “truth” campaign also realized
that they needed to use a message other then “don’t”. (17) The “truth” campaign
shows that more can be achieved through showing why not to do something instead
of saying “don’t” do something. The message of the serious risks of smoking
marijuana, such as losing friends or anxiety (13), should be delivered by
someone relatable to the youth instead of using a dog.

At the beginning of the paper, the different
components of the health belief model were discussed in relation to the
negative effects caused by the Above the Influence commercial. Here, the components will be discussed in
relation to delivering the National Youth Anti-Drug message to achieve
behavioral change in the targeted youths. To achieve perceived susceptibility,
marijuana should be reintroduced as harmful to strengthen the social norm that
drugs are not good. To achieve perceived severity, the commercial should focus
on the commonality of the risk factors associated with smoking marijuana. To
achieve perceived benefits, the focus should not be on avoiding health risks
but on a positive outcome. A benefit must be something relatable, unlike
talking to a dog. This could be spending time outside with friends, playing
rigorous sports, or participating in other group activities. (11) To show that there are no barriers, the
commercial should focus on groups of students staying away from drugs.
Self-efficacy can be achieved through reaching youths through the campaign, verbal
reinforcement and showing peers working together in the commercial to stay away
from marijuana. The goal of the campaign can be met through a commercial, if
the commercial uses the health benefit model to its advantage by studying the
social and behavioral components associated with the model.

Solution: The Psychological Reactance
Theory

The second critique that was
made about the Above the Influence commercial focuses on the psychological
reactance theory. This theory is used to describe the reaction of an individual
if their freedom of behavior is threatened or eliminated. In the commercial,
the goal of the dog is to relay the message of not smoking marijuana. The
campaign would have been more successful at delivering this message if the
message did not threaten the freedom of behavior. This problem can be solved without changing
the main message of the National Youth Anti-Drug Campaign. In changing the
commercial, the goal is to deflect reactance and increase compliance. When a
message threatens freedom of choice, there is a positive force to comply and a
negative force to react. In many cases of reactance, the negative force is the
more powerful force causing the reaction. The goal of the commercial should be
to reduce the negative force so that it is equal or less then the positive
force. Achieving this will increase compliance. (11)

The reduction of the negative
force of smoking marijuana can be achieved through using similarity. Delivering
the message by someone who the targeted youths relate too will increase the
positive force to comply and decrease the negative force to react. In the
current commercial, a dog delivers the message, which is not similar to the
targeted youth. This difference increases the negative force to react and
decreases the positive force to comply. (11) The commercial instead should have
an adolescent who is similar to the targeted youth deliver the message because
adolescents are influenced by their peers (15). This similarity would increase
the positive force to comply while decreasing the negative force to react. (11)
To create even more compliance, a person that many adolescents look up to such
as a celebrity should be used. A celebrity that is around the age of the
targeted youth from a band, movie or television show would further increase the
positive force and decrease the negative force of reactance. (14) Using a
celebrity would increase the positive force and decrease the negative force by
influencing the perception of the magnitude of the threat to freedom. Making a
few changes to the Above the Influence commercial, following the psychological
reactance theory would create a higher rate of compliance among the targeted
youth.

Solution: The Social Cognitive Theory

The third
critique that was made about the Above the Influence commercial focuses on the
social cognitive theory. This theory describes how different factors can cause
behavioral change in an individual. The three core determinants of this theory
were discussed above and will now be applied to make constructive changes to
the campaign commercial. The first determinant is outcome expectancies (8). In
the current commercial the outcome described is using marijuana to talk to a
dog. Instead, the commercial should be changed to highlight the real effects of
smoking marijuana. For example, the commercial could show that marijuana causes
anxiety and loss of friends (13) creating the condition for change. The second
and third determinant is perceived self-efficacy and goals. This part of the
commercial should highlight the mechanism by which the goal of not smoking is
achieved. The goal of not smoking marijuana should be delivered by a group of
people that the targeted youth can relate to as to demonstrate that the youth
can do it too. Using these determinants properly through a commercial can have
a large effect on implementing change in an individual’s health practice (8).

Changing the
commercial to include some of the key concepts of the social cognitive theory
can have a large impact on behavioral change. The first concept is
expectations. Instead of the expectation of getting high and talking with their
dog, the youth should understand the negative expectations associated with
smoking marijuana. Another concept is behavioral capability. In the commercial
the targeted youth observes someone who is similar to them being high. This
demonstrates that they have the ability to get high too. Instead, the
commercial should focus on someone who is similar to the youth not getting
high. The commercial could demonstrate other activities with the person
refusing to get high. The message of not smoking would be able to reach the
youth because they would know they have the ability to refuse to smoke
marijuana. Having the same widespread media impact as the Above the Influence
campaign already has would create reinforcements of the positive message. The
two other concepts of this theory are modeling and observational learning.
Using someone his or her age to model refusing to smoke marijuana is more
relatable then using a dog to deliver the campaigns message. This also gives
the opportunity for the targeted youth to learn through observation. Making
small changes based on the concepts and core determinants of the social
cognitive theory would have a large impact on the compliance of the targeted
youth. (8)